HEALING HANDS Vol. 16, No. 4 | Fall 2012
Decreasing Unintended Pregnancy among Women Experiencing Homelessness
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early half of pregnancies—49 percent—that occur annually in the US are unintended, which translates into about 3.2 million pregnancies being unwanted, unplanned, or mistimed (Guttmacher Institute, 2012a). The rate of unintended pregnancy in the US is significantly higher than the rate in many other developed nations, in spite of the fact that safe and highly effective contraceptives are available. The political and emotional nature of the discussions surrounding reproduction and sexuality impedes progress toward policy and practice changes that will protect the reproductive health of American women and significantly reduce the number of unintended pregnancies (Taylor, 2011).
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is more than twice the national low birthweight rate of 7.4 percent, and 18.5 percent of homeless women give birth pre-term (i.e., before 37 weeks) compared to the national average of 11 percent (Weinreb et al., 2004). A PUBLIC HEALTH ISSUE:WHY FAMILY PLANNING IS IMPORTANT According to the Centers for Disease Control and Prevention (CDC, 1999), family planning is one of the great public health achievements of the 20th century. Government agencies and private-sector experts have long recognized that reproductive health services are a vital and effective component of public health care, resulting in substantial positive consequences for infants, women, families, and society (Sonfield, 2011). In contrast, unintended pregnancy is associated with many negative maternal and child health outcomes (Guttmacher Institute, 2012b; US Department of Health and Human Services [HHS], 2011): n Delayed prenatal care n Depression and poor maternal mental health n Reduced mother-child relationship quality n Premature birth and poor developmental outcomes for children
According to the Guttmacher Institute (2012a), most American families want two children, resulting in the typical woman spending approximately five years pregnant, postpartum, or trying to become pregnant, and about three decades—more than three-quarters of her reproductive years—trying to avoid conception. By the time they reach 45, more than half of American women will have had an unintended pregnancy, with far-reaching health, social, and economic consequences. For homeless women, a high-risk group for unintended pregnancy, the situation is worse. At any given time about 10 percent of homeless women are pregnant, twice the rate (5 percent) of all US women of reproductive age. One study found that about threefourths (73 percent) of pregnancies among women experiencing homelessness were unintended at the time of conception (Gelberg, Lu, Leake, Andersen, Morgenstern, & Nyamathi, 2008). It is important to note that pregnancy and recent births are risk factors for becoming or continuing to be homeless (Weinreb, Gelberg, Arangua, & Sullivan, 2004).
Women with unintended pregnancies are more likely to use alcohol and tobacco during pregnancy, and unintended pregnancy that results in a live birth is associated with physical abuse and violence during pregnancy and the 12 months before conception (Santelli et al., 2003). A woman experiencing an unintended pregnancy faces the usual health risks of pregnancy—including maternal death— and closely spaced births are associated with additional health risks for mother and baby. A child from an unplanned conception is at greater risk of low birthweight, of dying in its first year of life, and of being abused (National Research Council, 2004). For these
Homeless women are more likely to receive inadequate prenatal care than are poor but housed women (39 percent versus 15 percent); consequently, their pregnancy outcomes are worse. The low birthweight rate among homeless women—16.8 percent—
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